Giuliani A, Calori S, Singlitico A, Forconi F, Maccauro G, Vitiello R
Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
Musculoskelet Surg. 2025 May 15. doi: 10.1007/s12306-025-00901-0.
Calcaneus fractures are severe injuries often resulting from traumatic falls or motor vehicle accidents. Surgical treatment through open reduction and internal fixation (ORIF) is considered the standard approach for displaced intra-articular calcaneal fractures (DIACFs), but it is associated with many complications. Our study aimed to review the current literature available on primary subtalar arthrodesis (PSA) as a first-line treatment for DIACFs, mostly Sanders type IV. In this study, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed, MEDLINE and the Cochrane Library. This review included articles where primary arthrodesis was performed in calcaneal fractures, with or without associated implants. Nine articles were included in the review. The total population comprised 184 patients with 192 calcaneal fractures. The mean age was 44.9 ± 6.9 years old. The mean follow-up period was 30.28 ± 15.29 months when reported. The mean time to surgery was 13.33 ± 7.02 days from injury. All studies reported a good fusion rate (between 94 and 100%) and an average fusion time of 4.05 ± 2.19 months. The mean American Orthopedic Foot & Ankle Society (AOFAS) score was 71.26 ± 8, and the mean Visual Analog Scale (VAS) score for pain was 3.26 ± 0.91. Primary arthrodesis of the subtalar joint for treating DIACFs, mostly Sanders type IV, provides good results due to the avoidance of further procedures, reduced postoperative pain, and a high rate of bony union. However, success heavily depends on factors such as patient comorbidities and addressing hindfoot deformity. Further studies with larger patient populations and more standardized protocols are necessary to draw definitive conclusions about the best management strategies for DIACFs. Systematic review, level III of evidence.
跟骨骨折是严重损伤，常由创伤性跌倒或机动车事故导致。切开复位内固定术（ORIF）的手术治疗被认为是移位性关节内跟骨骨折（DIACF）的标准方法，但它伴有许多并发症。我们的研究旨在回顾目前关于一期距下关节融合术（PSA）作为DIACF（主要是Sanders IV型）一线治疗方法的文献。在本研究中，我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了系统评价。在PubMed、MEDLINE和Cochrane图书馆中搜索关键词。本综述纳入了在跟骨骨折中进行一期关节融合术的文章，无论是否使用相关植入物。该综述纳入了9篇文章。总共有184例患者，共192处跟骨骨折。平均年龄为44.9±6.9岁。报告的平均随访期为30.28±15.29个月。受伤至手术的平均时间为13.33±7.02天。所有研究均报告了良好的融合率（94%至100%），平均融合时间为4.05±2.19个月。美国矫形足踝协会（AOFAS）平均评分为71.26±8，疼痛视觉模拟量表（VAS）平均评分为3.26±0.91。一期距下关节融合术治疗DIACF（主要是Sanders IV型），由于避免了进一步手术、减轻了术后疼痛以及骨愈合率高，因此效果良好。然而，成功很大程度上取决于患者合并症和解决后足畸形等因素。需要开展更大患者群体和更标准化方案的进一步研究，以得出关于DIACF最佳管理策略的确切结论。系统评价，证据等级III级。
